• Kirsten Paulus, Bauerle BassSarahS0000-0003-2742-1609Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsyl, Whitney Cabey, Katie Singley, Caseem Luck, Ariel Hoadley, Molly Kerstetter, Alexandru-Mircea Rotaru, Elizabeth Knight, Swathi Murali, Shreya Verma, Imani Wilson-Shabazz, and Heather Gardiner.
• Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.
• Ann. Med. 2024 Dec 1; 56 (1): 24011222401122.

BackgroundUnderlying causes of vaccine hesitancy could significantly affect successful uptake of the SARS-CoV2 vaccine booster doses during new waves of COVID-19. Booster rates among US adults are far below what is needed for immunity, but little is known about booster hesitancy among fully vaccinated adults and whether medical mistrust exacerbates barriers to uptake.MethodsA cross-sectional survey was completed among 119 adults in Philadelphia, PA who reported having received the primary SARS-CoV2 vaccine series but not a booster dose. Using the LaVeist Medical Mistrust (MM) Index, a k-means cluster analysis showed two clusters (Low MM, High MM) and differences in attitudes and perceptions about COVID-19 booster vaccines were assessed using F-tests.ResultsRespondents were 62% Black and female; mean age was 41; 46% reported earning less than $25,000 and 53% had a high school education or less. Overall intention to get boosted was low (mean 3.3 on 0-10 scale). Differences in COVID-19 booster perceptions between those with High (n = 56) vs. Low (n = 59) MM were found, independent of any demographic differences. Most statements (7/10) related to reasons to not be boosted were significant, with those with High MM indicating more concern about feeling sick from the vaccine (F=-3.91, p≤ .001), beliefs that boosters are ineffective for vaccinated people (F= -3.46, p≤ .001), and long-term side effect worries (F=-4.34, p≤ .001). Those with High MM were also more concerned about the adverse effects of the vaccine (F=-2.48, p=.02), but were more likely to trust getting information from doctors or healthcare providers (F= -2.25, p=.03).ConclusionsResults indicate that medical mistrust is an important independent construct when understanding current COVID-19 booster hesitancy. While much work has looked at demographic differences to explain vaccine hesitancy, these results suggest that further research into understanding and addressing medical mistrust could be important for implementing interventions to increase booster rates.

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